Nursing Elites

1. In which situation is the nurse upholding the ethical principle of fidelity?

• A. Providing complete information regarding treatment options to a client with newly diagnosed cancer
• B. Allowing a client to decide when to receive daily hygiene care
• C. Inserting a 19-gauge intravenous catheter into a client requiring a blood transfusion
• D. Contacting the health care provider about the client's request to incorporate complementary therapies for pain into the treatment plan

Correct answer: D

Rationale: Fidelity is the ethical principle of keeping promises made to clients, families, and other healthcare professionals. Contacting the health care provider about the client's request to incorporate complementary therapies for pain into the treatment plan exemplifies fidelity. By advocating for the client's preferences and ensuring their requests are addressed, the nurse demonstrates a commitment to fulfilling promises made to the client. Allowing a client to decide when to receive daily hygiene care relates to respecting autonomy, not fidelity. Inserting a 19-gauge intravenous catheter into a client needing a blood transfusion aligns with beneficence, as it involves taking action to provide necessary treatment. Providing complete information to a client with newly diagnosed cancer about treatment options reflects justice, promoting fairness and equity in healthcare by offering equal access to information and treatment choices.

2. Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be

• A. Outbreak of Asian flu.
• B. Chemical exposure.
• C. Bacterial pneumonia.
• D. Allergic reaction.

Correct answer: B

Rationale: In the scenario described, where multiple passengers on an airliner experience sudden weakness and breathing difficulty simultaneously, the most likely cause is chemical exposure. This is because a sudden onset of similar symptoms in a group of individuals suggests a common environmental factor affecting them. Options A, C, and D are less likely as they do not explain a sudden onset of symptoms in multiple individuals simultaneously. Asian flu (Option A) is a viral infection and would not typically result in sudden symptoms in multiple individuals at the same time. Bacterial pneumonia (Option C) is a localized infection and not a probable cause for a sudden onset of symptoms in a group. An allergic reaction (Option D) would usually occur in individuals with specific allergies rather than affecting a group of passengers at the same time.

3. A health care provider informs a nurse that the husband of an unconscious client with terminal cancer will not grant permission for a do-not-resuscitate (DNR) order. The health care provider tells the nurse to perform a 'slow code' and let the client 'rest in peace' if she stops breathing. How should the nurse respond?

• A. Telling the health care provider that the client would probably want to die in peace
• B. Telling the health care provider that if the client stops breathing, the health care provider will be called before any other actions are taken
• C. Telling the health care provider that all of the nurses on the unit agree with this plan
• D. Telling the health care provider that 'slow codes' are not acceptable

Correct answer: D

Rationale: The nurse may not violate a family's request regarding the client's treatment plan. A 'slow code' is not acceptable, and the nurse should state this to the health care provider. The definition of a 'slow code' varies among health care facilities and personnel and could be interpreted as not performing resuscitative procedures as quickly as a competent person would. Resuscitative procedures that are performed more slowly than recommended by the American Heart Association are below the standard of care and could therefore serve as the basis for a lawsuit. The other options are inappropriate: Option A is speculative and does not address the issue directly; Option B does not challenge the unethical practice of a 'slow code'; Option C is irrelevant and does not address the ethical concerns raised by the health care provider's request.

4. What sign might the nurse observe in a client with a high ammonia level?

• A. coma
• B. edema
• C. hypoxia
• D. polyuria

Correct answer: A

Rationale: Coma is a sign that a nurse might observe in a client with a high ammonia level. Elevated ammonia levels can lead to hepatic encephalopathy, a condition characterized by impaired brain function, which can progress to coma. Edema (choice B) is swelling caused by excess fluid trapped in body tissues, not typically associated with high ammonia levels. Hypoxia (choice C) is a condition of inadequate oxygen supply to tissues and is not directly related to high ammonia levels. Polyuria (choice D) refers to excessive urination and is not a typical sign of high ammonia levels.

5. Distribution of a drug to various tissues depends on the amount of cardiac output to each type of tissue. Which tissue would receive the highest amount of cardiac output and thus the highest amount of a drug?

• A. skin
• B. adipose tissue
• C. skeletal muscle
• D. myocardium

Correct answer: D

Rationale: The correct answer is 'myocardium.' Highly perfused tissues include vital organs like the brain, heart, kidneys, adrenal glands, and liver. The myocardium, being heart muscle, receives the highest amount of cardiac output and thus the highest amount of a drug. Choices A, B, and C are incorrect because the skin and adipose tissue are poorly perfused, while skeletal muscle is less perfused compared to vital organs like the myocardium.

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